Heparin: the cheap alternative for immunomodulation in sepsis?

Area of Science:

• Critical care medicine
• Immunology
• Pharmacology

Background:

• Severe sepsis is a major cause of mortality in intensive care units worldwide.
• Current treatments involve antibiotics and supportive care, but survival benefits from immunomodulatory agents have been inconsistent.
• Previous studies noted potential confounding effects of heparin, suggesting non-anticoagulant roles.

Purpose of the Study:

• To review the clinical effects of heparin.
• To explore the potential immunomodulatory actions of heparin in severe sepsis.
• To discuss the implications of heparin's widespread therapeutic use.

Main Methods:

• Literature review of clinical studies on severe sepsis and heparin.
• Analysis of studies investigating recombinant human activated protein C and anticoagulant agents.
• Examination of potential confounding factors, including low-dose heparin administration.

Main Results:

• Recombinant human activated protein C showed initial survival benefit, but subsequent studies did not confirm this.
• Inconsistent survival benefits were observed with other immunomodulatory agents.
• Heparin's presence in studies suggested potential non-anticoagulant immunomodulatory effects.

Conclusions:

• Heparin's non-anticoagulant properties warrant further investigation for therapeutic potential in severe sepsis.
• The widespread use of heparin necessitates a deeper understanding of its immunomodulatory actions.
• Further research is crucial to elucidate heparin's role in managing severe sepsis.